| NPI | 1982670584 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 100282) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: PA CW014547) |
| Enumeration Date | 2006-02-24 |
| Last Update Date | 2024-04-25 |